Q: I am in my late 60s and in the past few days noticed a tingling sensation on the top of my head. It was almost like an itch, but I didn’t know where to scratch. Then one morning I woke up to find what looked like a bite on the side of my face. I didn’t notice any insect but figured it would settle down. A day later, I noticed another little area close to the first bite. It was sore and red, but wasn’t making me feel sick. Now I have another red sore looking area on my ear lobe. My scalp still feels weird and has a few bumps in it that are sore. What could it be?
Dr Grant replies: It sounds like you have developed shingles. I bet you would have noticed small round yellow vesicles within the red patch of skin that initially looked like an insect bite. Shingles is caused by the same virus that causes chicken pox in childhood. Only if you come across another person who never had chicken pox as a child, then you pose a risk to them getting chicken pox as an adult which can be a more serious illness. This is particularly important if the person is pregnant, so make sure to avoid contact with pregnant women who have never had chickenpox. In general, a person with shingles is much less likely to transmit the virus compared to a person with chickenpox. Shingles is not infectious before vesicles appear and is no longer infectious once the skin lesions have crusted over.
Approximately 95pc of the adult population has been exposed to the herpes zoster (HZ) virus and it is estimated about 25pc will experience an attack of shingles in their lifetime. The HZ virus lies dormant in our nervous system and can be reactivated commonly during periods of stress, during cancer treatment, while on treatment for lymphoma, leukaemia, in patients on high dose corticosteroids/immunosuppressive medication or in patients with HIV.
Classically, the rash and symptoms affect one side of the body and follow the distribution of a dermatome which is an area of skin supplied by nerve fibers from a single spinal nerve. Dermatome maps can be easily found on the internet. The rash is generally limited to one dermatome, but can occasionally affect two or three neighbouring dermatomes.
In your case, it’s most likely C2 and/or C3 nerve from your cervical spine with HZ virus reactivation. There is a second clinical manifestations of HZ virus is known as acute neuritis causing pain described as a deep “burning,” “throbbing,” or “stabbing” sensation. Neuritis means inflammation in the nerve that supplies the skin and often precedes or occurs simultaneously with the rash.
Shingles often affects the thoracic (upper chest and back), the head/neck region and if the rash appears close to the eye it is a serious sight-threatening condition. You must seek treatment from an eye doctor as soon as possible to prevent permanent eye damage. Acute HZ virus infection around the eye can cause conjunctivitis, episcleritis, keratitis, and/or iritis.
Anyone over 50 can get the shingles vaccine. Even if you’ve had shingles before, you can still have the vaccination provided it’s been over a year since you had your attack. The vaccine helps reduce your risk of developing shingles by over 60pc and reduces your risk of developing post herpetic neuralgia by up to 88pc.
Dr Jennifer Grant is a GP with Beacon HealthCheck